Reproductive - Pathology (2) Flashcards Preview

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Flashcards in Reproductive - Pathology (2) Deck (41):
1

Fibromas

  • Type of tumor
  • Findings

  • Type of tumor
    • Benign ovarian neoplasm
  • Findings
    • Bundles of spindle-shaped fibroblasts.
    • Meigs syndrome—triad of ovarian fibroma, ascites, and hydrothorax.
    • Pulling sensation in groin.

2

Thecoma

  • Type of tumor
  • Findings

  • Type of tumor
    • Benign ovarian neoplasm
  • Findings
    • Like granulosa cell tumors, may produce estrogen.
    • Usually present as abnormal uterine bleeding in a postmenopausal woman.

3

Immature teratoma

  • Type of tumor
  • Definition

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Aggressive
    • Contains fetal tissue, neuroectoderm.
  • Findings
    • Mature teratoma are more likely to contain thyroid tissue.
    • Immature teratoma is most typically represented by immature/embryonic-like neural tissue

4

Granulosa cell tumor

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Most common sex cord stromal tumor.
    • Predominantly women in their 50s.
  • Findings
    • Often produce estrogen and/or progesterone and present with abnormal uterine bleeding, sexual precocity (in pre-adolescents), breast tenderness.
    • Histology shows Call-Exner bodies (resemble primordial follicles).

5

Serous cystadenocarcinoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Most common ovarian neoplasm
    • Frequently bilateral.
  • Findings
    • Psammoma bodies.

6

Mucinous cystadenocarcinoma

  • Type of tumor
  • Definition

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Pseudomyxoma peritonei–intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

7

Dysgerminoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Most common in adolescents.
    • Equivalent to male seminoma but rarer.
    • 1% of all ovarian tumors; 30% of germ cell tumors.
    • hCG, LDH = tumor markers.
  • Findings
    • Sheets of uniform “fried egg” cells [D]

8

Choriocarcinoma

  • Type of tumor
  • Definition
  • Findings
  • Treatment

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Rare
    • Can develop during or after pregnancy in mother or baby.
    • Malignancy of trophoblastic tissue [E] (cytotrophoblasts, syncytiotrophoblasts)
  • Findings
    • No chorionic villi present. 
    • Increased frequency of theca-lutein cysts.
    • Presents with abnormal β-hCG, shortness of breath, hemoptysis.
    • Hematogenous spread to lungs.
  • Treatment
    • Very responsive to chemotherapy.

9

Yolk sac (endodermal sinus) tumor

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children.
    • Most common tumor in male infants.
  • Findings
    • Yellow, friable (hemorrhagic), solid mass.
    • 50% have Schiller-Duval bodies (resemble glomeruli) [F].
    • AFP = tumor marker.

10

Krukenberg tumor

  • Type of tumor
  • Definition

  • Type of tumor
    • Malignant ovarian neoplasm
  • Definition
    • GI malignancy that metastasizes to the ovaries, causing a mucin-secreting signet cell adenocarcinoma.

11

Vaginal tumors

  • Squamous cell carcinoma (SCC)
  • Clear cell adenocarcinoma
  • Sarcoma botryoides (rhabdomyosarcoma variant)

  • Squamous cell carcinoma (SCC)
    • Usually 2° to cervical SCC
    • 1° vaginal carcinoma rare.
  • Clear cell adenocarcinoma
    • Affects women who had exposure to DES in utero.
  • Sarcoma botryoides (rhabdomyosarcoma variant)
    • Affects girls < 4 years old
    • Spindle-shaped tumor cells that are desmin (+).

12

Breast pathology (584)

  • Stroma
  • Lobules
  • Terminal duct
  • Major duct
  • Lactiferous sinus
  • Nipple

  • Stroma
    • Fibroadenoma
    • Phyllodes tumor
  • Lobules
    • Lobular carcinoma
  • Terminal duct
    • Tubular carcinoma
  • Major duct
    • Fibrocystic change
    • DCIS
    • Invasive ductal carcinoma
  • Lactiferous sinus
    • Intraductal papilloma
    • Abscess / mastitis
  • Nipple
    • Paget disease
    • Breast abscess

13

Fibroadenoma

  • Type of tumor
  • Characteristics
  • Epidemiology
  • Notes

  • Type of tumor
    • Benign breast tumor
  • Characteristics
    • Small, mobile, firm mass with sharp edges.
  • Epidemiology
    • Most common tumor in those < 35 years old.
  • Notes
    • Increased size and tenderness with increased estrogen (e.g., pregnancy,
      prior to menstruation).
    • Not a precursor to breast cancer.

14

Intraductal papilloma

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Benign breast tumor
  • Characteristics
    • Small tumor that grows in lactiferous ducts.
    • Typically beneath areola.
  • Notes
    • Serous or bloody nipple discharge.
    • Slight (1.5–2×) increase in risk for carcinoma.

15

Phyllodes tumor

  • Type of tumor
  • Characteristics
  • Epidemiology
  • Notes

  • Type of tumor
    • Benign breast tumor
  • Characteristics
    • Large bulky mass of connective tissue and cysts.
    • “Leaf-like” projections.
  • Epidemiology
    • Most common in 6th decade.
  • Notes
    • Some may become malignant.

16

Malignant breast tumors

  • Definition
  • Due to...
  • Prognosis
  • Risk factors

  • Definition
    • Commonly postmenopausal.
    • Usually arise from terminal duct lobular unit.
    • Most often located in upper-outer quadrant of breast
  • Due to...
    • Overexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common
    • Triple negative (ER (-), PR (-), and Her2/Neu (-)) more aggressive
  • Prognosis
    • Type affects therapy and prognosis
    • Axillary lymph node involvement indicating metastasis is the single most important prognostic factor.
  • Risk factors
    • Increased estrogen exposure, increased total number of menstrual cycles, older age at 1st live birth, obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone), BRCA1 and BRCA2 gene mutations, African American ethnicity (increased risk for triple (-) breast cancer).

17

Ductal carcinoma in situ (DCIS)

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Noninvasive malignant breast tumor
  • Characteristics
    • Fills ductal lumen.
    • Arises from ductal atypia [A].
    • Often seen early as microcalcifications on mammography
  • Notes
    • Early malignancy without basement membrane penetration.

18

Comedocarcinoma

  • Type of tumor
  • Characteristics

  • Type of tumor
    • Noninvasive malignant breast tumor
  • Characteristics
    • Ductal, caseous necrosis [B].
    • Subtype of DCIS.

19

Paget disease

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Noninvasive malignant breast tumor
  • Characteristics
    • Results from underlying DCIS.
    • Eczematous patches on nipple.
    • Paget cells = large cells in epidermis with clear halo [C].
  • Notes
    • Suggests underlying DCIS.
    • Also seen on vulva, though does not suggest underlying malignancy.

20

Invasive ductal tumor

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Invasive malignant breast tumor
  • Characteristics
    • Firm, fibrous, “rock-hard” mass with sharp margins and small, glandular, duct-like cells.
    • Grossly, see classic “stellate” infiltration.
  • Notes
    • Worst and most invasive.
    • Most common (76% of all breast cancers).

21

Invasive lobular tumor

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Invasive malignant breast tumor
  • Characteristics
    • Orderly row of cells (“Indian file”).
  • Notes
    • Often bilateral with multiple lesions in the same location.

22

Medullary tumor

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Invasive malignant breast tumor
  • Characteristics
    • Fleshy, cellular, lymphocytic infiltrate.
  • Notes
    • Good prognosis.

23

Inflammatory tumor

  • Type of tumor
  • Characteristics
  • Notes

  • Type of tumor
    • Invasive malignant breast tumor
  • Characteristics
    • Dermal lymphatic invasion by breast carcinoma.
    • Peau d’orange (breast skin resembles orange peel)
    • Neoplastic cells block lymphatic drainage.
  • Notes
    • 50% survival at 5 years.

24

Proliferative breast disease

  • Definition
  • Findings
  • Histologic types
    • Fibrosis
    • Cystic
    • Sclerosing adenosis
    • Epithelial hyperplasia

  • Definition
    • Most common cause of “breast lumps” from age 25 to menopause.
  • Findings
    • Presents with premenstrual breast pain and multiple lesions, often bilateral.
    • Fluctuation in size of mass.
    • Usually does not indicate increased risk of carcinoma.
  • Histologic types
    • Fibrosis
      • Hyperplasia of breast stroma.
    • Cystic
      • Fluid filled, blue dome.
      • Ductal dilation.
    • Sclerosing adenosis
      • Increased acini and intralobular fibrosis.
      • Associated with calcifications.
      • Often confused with cancer.
      • Increased risk (1.5–2×) of developing cancer.
    • Epithelial hyperplasia
      • Increase in number of epithelial cell layers in terminal duct lobule. 
      • Increased risk of carcinoma with atypical cells.
      • Occurs in women > 30 years old.

25

Common breast conditions

  • Acute mastitis
    • Definition
    • Treatment
  • Fat necrosis
    • Definition
    • Findings

  • Acute mastitis
    • Definition
      • Breast abscess
      • During breast-feeding, increased risk of bacterial infection through cracks in the nipple
      • S. aureus is the most common pathogen.
    • Treatment
      • Treat with dicloxacillin and continued breast-feeding.
  • Fat necrosis
    • Definition
      • A benign, usually painless lump
      • Forms as a result of injury to breast tissue.
      • Up to 50% of patients may not report trauma
    • Findings
      • Abnormal calcification on mammography
      • Biopsy shows necrotic fat, giant cells.

26

Gynecomastia

  • Definition
  • Results from...

  • Definition
    • Common breast condition
    • Occurs in males [A].
  • Results from...
    • Hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
    • Klinefelter syndrome
    • Drugs (Spironolactone, marijuana [Dope], Digitalis, Estrogen, Cimetidine, Alcohol, Heroin, Dopamine D2 antagonists, Ketoconazole).
      • Some Dope Drugs Easily Create Awkward Hairy DD Knockers.”

27

Prostate pathology

  • Prostatitis
  • Acute
  • Chronic

  • Prostatitis
    • Dysuria, frequency, urgency, low back pain.
  • Acute
    • Bacterial (e.g., E. coli)
  • Chronic
    • Bacterial or abacterial (most common).

28

Benign prostatic hyperplasia

  • Definition
  • Findings
  • Treatment

  • Definition
    • Common in men > 50 years old.
    • Hyperplasia (not hypertrophy) of the prostate gland.
    • Not considered a premalignant lesion.
  • Findings
    • Characterized by a smooth, elastic, firm nodular enlargement of the periurethral (lateral and middle) lobes, which compress the urethra into a vertical slit.
    • Often presents with increased frequency of urination, nocturia, difficulty starting and stopping the stream of urine, and dysuria.
    • May lead to distention and hypertrophy of the bladder, hydronephrosis, and UTIs.
    • Increased free prostatespecific antigen (PSA).
  • Treatment
    • α1-antagonists (terazosin, tamsulosin), which cause relaxation of smooth muscle
    • Finasteride.

29

Prostatic adenocarcinoma

  • Definition
  • Findings
  • Due to...
  • Diagnosis

  • Definition
    • Common in men > 50 years old.
  • Findings
    • Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain and an increase in serum ALP and PSA
  • Due to...
    • Arises most often from the posterior lobe (peripheral zone) of the prostate gland [A]
  • Diagnosis
    • Most frequently diagnosed by increased PSA and subsequent needle core biopsies.
    • Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (increased total PSA, with decreased fraction of free PSA).

30

Cryptorchidism

  • Definition
  • Findings
  • Associations

  • Definition
    • Undescended testis (one or both)
  • Findings
    • Impaired spermatogenesis (since sperm develop best at temperatures < 37°C)
    • Can have normal testosterone levels (Leydig cells are unaffected by temperature)
    • Decreased inhibin, increased FSH, and increased LH
    • Testosterone decreased in bilateral cryptorchidism, normal in unilateral
  • Associations
    • Associated with increased risk of germ cell tumors.
    • Prematurity increases the risk of cryptorchidism. 

31

Varicocele

  • Definition
  • Findings
  • Diagnosis
  • Treatment

  • Definition
    • Dilated veins in pampiniform plexus as a result of increased venous pressure
    • Most common cause of scrotal enlargement in adult males
    • Can cause infertility because of increased temperature
  • Findings
    • Most often on the left side because of increased resistance to flow from left gonadal vein drainage into the left renal vein
    • “Bag of worms” appearance
  • Diagnosis
    • Diagnosed by ultrasound with Doppler [A].
  • Treatment
    • Varicocelectomy, embolization by interventional radiologist.

32

Testicular germ cell tumors

  • Definition
  • Risk factors
  • Findings
  • Differential diagnosis for testicular mass that does not transilluminate

  • Definition
    • ~95% of all testicular tumors.
    • Most often occur in young men.
  • Risk factors
    • Cryptorchidism, Klinefelter syndrome.
  • Findings
    • Can present as a mixed germ cell tumor.
  • Differential diagnosis for testicular mass that does not transilluminate
    • Cancer.

33

Seminoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Testicular germ cell tumor
  • Definition
    • Malignant 
    • Painless, homogenous testicular enlargement 
    • Most common testicular tumor 
    • Most common in 3rd decade, never in infancy.
    • Late metastasis, excellent prognosis
  • Findings
    • Painless, homogenous testicular enlargement
    • Large cells in lobules with watery cytoplasm and a “fried egg” appearance. 
    • Increased placental ALP.
    • Radiosensitive. 

34

Yolk sac (endodermal sinus) tumor

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Testicular germ cell tumor
  • Definition
    • Aggressive malignancy of testes, analogous to ovarian yolk sac tumor.
    • Most common testicular tumor in boys < 3 years old.
  • Findings
    • Yellow, mucinous.
    • Schiller-Duval bodies resemble primitive glomeruli.

35

Choriocarcinoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Testicular germ cell tumor
  • Definition
    • Malignant
    • Disordered syncytiotrophoblastic and cytotrophoblastic elements.
  • Findings
    • Increased hCG
    • Hematogenous metastases to lungs and brain
    • May present with “hemorrhagic stroke” due to bleeding into the metastasis
    • May produce gynecomastia or symptoms of hyperthyroidism (hCG is an LH and TSH analog).

36

Teratoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Testicular germ cell tumor
  • Definition
    • Unlike in females, mature teratoma in adult males may be malignant.
    • Benign in children.
  • Findings
    • Increased hCG and/or AFP in 50% of cases.

37

Embryonal carcinoma

  • Type of tumor
  • Definition
  • Findings

  • Type of tumor
    • Testicular germ cell tumor
  • Definition
    • Malignant, hemorrhagic mass with necrosis
    • Worse prognosis than seminoma
    • “Pure” embryonal carcinoma is rare
      • Most commonly mixed with other tumor types
  • Findings
    • Painful
    • Often glandular/papillary morphology.
    • May be associated with increased hCG and normal AFP levels when pure (increased AFP when mixed)

38

Testicular non–germ cell tumors

  • Definition
  • Leydig cell 
  • Sertoli cell
  • Testicular lymphoma 

  • Definition
    • 5% of all testicular tumors.
    • Mostly benign.
  • Leydig cell
    • Contains Reinke crystals
    • Usually androgen producing, gynecomastia in men, precocious puberty in boys.
    • Golden brown color.
  • Sertoli cell
    • Androblastoma from sex cord stroma.
  • Testicular lymphoma
    • Most common testicular cancer in older men.
    • Not a primary cancer, arises from lymphoma metastases to testes.
    • Aggressive.

39

Tunica vaginalis lesions

  • Definition
  • Hydrocele
  • Spermatocele

  • Definition
    • Lesions in the serous covering of testis present as testicular masses that can be transilluminated (vs. testicular tumors).
  • Hydrocele
    • Increased fluid 2º to incomplete obliteration of processus vaginalis
  • Spermatocele
    • Dilated epididymal duct

40

Penile pathology:
Squamous cell carcinoma

  • Geography
  • Precursor in situ lesions
  • Associations

  • Geography
    • More common in Asia, Africa, and South America.
  • Precursor in situ lesions
    • Bowen disease (in penile shaft, presents as leukoplakia)
    • Erythroplasia of Queyrat (cancer of glans, presents as erythroplakia)
    • Bowenoid papulosis (presents as reddish papules).
  • Associations
    • Associated with HPV, lack of circumcision.

41

Penile pathology:
Priapism

  • Definition
  • Associations

  • Definition
    • Painful sustained erection not associated with sexual stimulation or desire.
  • Associations
    • Associated with trauma, sickle cell disease (sickled RBCs get trapped in vascular channels), medications (anticoagulants, PDE-5 inhibitors, antidepressants, α-blockers, cocaine).

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